New Work Injury Insurance Regulations 2015

Chapter I General Provisions

Article 1 These Regulations are formulated in order to ensure that employees who suffer from accidents or occupational diseases at work can obtain medical treatment and economic compensation, promote occupational injury prevention and rehabilitation, and disperse the risk of occupational injuries of the employing units.

Article 2 Enterprises, institutions, social organizations, people run non enterprise units, foundations, law firms, accounting firms and other organizations within the territory of the People's Republic of China as well as self-employed industrial and commercial households (hereinafter referred to as "employing units") with employees shall, in accordance with the provisions of these Regulations, participate in work-related injury insurance and pay work-related injury insurance premiums for all employees or employees of the unit (hereinafter referred to as "employees").
Employees of enterprises, institutions, social organizations, private non enterprise units, foundations, law firms, accounting firms and other organizations within the territory of the People's Republic of China and employees of self-employed businesses have the right to enjoy work-related injury insurance benefits in accordance with the provisions of these Regulations.

Article 3 The collection and payment of industrial injury insurance premiums shall be carried out in accordance with the provisions of the Interim Regulations on the Collection and Payment of Social Insurance Premiums on the collection and payment of basic endowment insurance premiums, basic medical insurance premiums and unemployment insurance premiums.

Article 4 The employing unit shall publicize the relevant information about the employment injury insurance in its own unit.
The Employer and employees shall abide by the laws and regulations on production safety and occupational disease prevention, implement the safety and health regulations and standards, prevent industrial accidents, and avoid and reduce occupational disease hazards.
In case of work-related injuries, the employing unit shall take measures to enable the injured workers to receive timely treatment.

Article 5 The social insurance administrative department of the State Council shall be responsible for the work of work-related injury insurance throughout the country.
The social insurance administrative departments of the local people's governments at or above the county level shall be responsible for the work of industrial injury insurance within their respective administrative areas.
The social insurance agency established by the social insurance administrative department in accordance with the relevant provisions of the State Council (hereinafter referred to as the agency) shall specifically undertake the work injury insurance affairs.

Article 6 The social insurance administrative departments and other departments shall solicit the opinions of the trade union organizations and the representatives of the employing units when formulating policies and standards for work-related injury insurance

Chapter II Industrial Injury Insurance Fund

Article 7 The work-related injury insurance fund shall consist of the work-related injury insurance premium paid by the employing unit, the interest of the work-related injury insurance fund and other funds incorporated into the work-related injury insurance fund according to law.
Article 8 The rate of work-related injury insurance premium shall be determined according to the principle of payment and collection and balance of income and expenditure.

The state determines the different rates of different industries according to the degree of industrial injury risk in different industries, and determines several rate grades in each industry according to the use of industrial injury insurance premiums, the incidence of industrial injury, etc. The industrial differential rate and the grade of intra industry rate shall be formulated by the social insurance administrative department of the State Council and published for implementation after being approved by the State Council.
The regional agency for overall planning shall determine the unit payment rate according to the use of the employer's industrial injury insurance premium, the incidence rate of industrial injury, and the corresponding rate grade within the industry.

Article 9 The social insurance administrative department of the State Council shall regularly learn about the income and expenditure of the industrial injury insurance funds in various areas of the country, and timely propose a plan for adjusting the industrial differential rates and the grade of intra industry rates, which shall be published and implemented after being submitted to the State Council for approval.

Article 10 The employing unit shall pay the work injury insurance premiums on time. Employees do not pay the industrial injury insurance premium.
The amount of work-related injury insurance premium paid by the employer shall be the product of the total wages of the employees of the employer multiplied by the unit contribution rate.
For industries that are difficult to pay the industrial injury insurance premium according to the total wages, the specific ways of paying the industrial injury insurance premium shall be stipulated by the social insurance administrative department of the State Council.

Article 11 The work injury insurance fund shall be gradually unified at the provincial level.
Cross regional and highly mobile industries can take a relatively centralized way to participate in the industrial injury insurance in the overall planning area. The specific measures shall be formulated by the social insurance administrative department of the State Council in conjunction with the competent departments of relevant industries.

Article 12 The industrial injury insurance fund shall be deposited in the special financial account of the social security fund for the payment of the industrial injury insurance benefits, the appraisal of labor capacity, the publicity and training of industrial injury prevention, and other expenses for industrial injury insurance as stipulated in these Regulations, as well as other expenses for industrial injury insurance as stipulated by laws and regulations.

The specific measures for the allocation proportion, use and management of occupational injury prevention expenses shall be formulated by the social insurance administrative department under the State Council in conjunction with the finance, health administration, work safety supervision and administration departments under the State Council.
No unit or individual may use the work-related injury insurance fund for investment and operation, construction or reconstruction of office space, payment of bonuses, or other purposes.

Article 13 The industrial injury insurance fund shall retain a certain proportion of reserves for the overall payment of industrial injury insurance benefits for major accidents in the region; If the reserve fund is insufficient to pay, it shall be advanced by the people's government of the overall planning area. The specific proportion of reserves in the total amount of the fund and the method for the use of reserves shall be formulated by the people's governments of provinces, autonomous regions and municipalities directly under the Central Government.

Chapter III Determination of Work related Injuries

Article 14 In any of the following circumstances, an employee shall be deemed as an industrial injury:
（1） Injuries caused by accidents during working hours and in the workplace;
（2） Those who are injured by accidents while engaged in preparatory or finishing work related to work in the workplace before or after working hours;
（3） Accidental injuries such as violence during working hours and in the workplace due to performance of work duties;
（4） Suffering from occupational disease;
（5） Injuries due to work or unknown whereabouts due to accidents during the period of going out for work;
（6） Injured by a traffic accident for which he is not primarily responsible or an urban rail transit, passenger ferry or train accident on the way to and from work;
（7） Other circumstances that shall be recognized as work-related injuries according to laws and administrative regulations.
Article 15 In any of the following circumstances, an employee shall be deemed as an industrial injury:
（1） Death due to sudden illness or death due to ineffective rescue within 48 hours during working hours and post;
（2） Injured in activities of safeguarding national interests and public interests such as rescue and disaster relief;
（3） Employees who were formerly in the military and were disabled due to war or business injuries, have obtained revolutionary disabled soldier certificates, and have relapsed after arriving at the employing unit.
In case of any of the situations mentioned in Items (1) and (2) of the preceding paragraph, the employees shall enjoy the benefits of work-related injury insurance in accordance with the relevant provisions of these Regulations; In case of any of the circumstances specified in Item (3) of the preceding paragraph, employees shall be entitled to industrial injury insurance benefits other than one-time disability subsidies in accordance with the relevant provisions of these Regulations.

Article 16 Employees shall comply with the provisions of Article 14 and Article 15 of these Regulations, but shall not be deemed as work-related injury or deemed as work-related injury in any of the following circumstances:
（1） Deliberately committing a crime;
（2） Being drunk or taking drugs;
（3） Self mutilation or suicide.

Article 17 Where an employee suffers from an accident injury or is diagnosed and identified as an occupational disease according to the provisions of the Occupational Disease Prevention Law, the unit to which the employee belongs shall, within 30 days from the date of the accident injury or the date of the diagnosis and identification as an occupational disease, apply to the social insurance administrative department of the overall planning area for recognition of the occupational injury. In case of special circumstances, the application time limit may be appropriately extended with the approval of the social insurance administrative department.

If the employer fails to apply for recognition of work-related injury according to the provisions of the preceding paragraph, the injured worker or his close relatives or trade union organization may directly apply for recognition of work-related injury to the social insurance administrative department of the overall planning area where the employer is located within one year from the date of the occurrence of the accident injury or the date of the diagnosis and identification of the occupational disease.

In accordance with the provisions of the first paragraph of this article, the matters that should be recognized by the provincial social insurance administrative department for work-related injury shall be handled by the social insurance administrative department of the city divided into districts where the employer is located according to the principle of territoriality.

If the employer fails to submit an application for identification of work-related injury within the time limit specified in the first paragraph of this Article, the employer shall bear the expenses related to work-related injury treatment that meet the provisions of these Regulations during this period.

Article 18 The following materials shall be submitted to apply for recognition of work-related injuries:
（1） Application Form for Occupational Injury Identification;
（2） Materials proving the existence of labor relationship (including factual labor relationship) with the employer;
（3） Medical diagnosis certificate or occupational disease diagnosis certificate (or occupational disease diagnosis appraisal certificate).
The application form for identification of work-related injury shall include the time, place, cause of the accident and the degree of employee injury.
If the materials provided by the applicant for determination of work-related injury are incomplete, the social insurance administrative department shall inform the applicant of all the materials that need to be supplemented and corrected in writing at one time. The social insurance administrative department shall accept the application after the applicant has supplemented and corrected the materials as required by the written notice.

Article 19 After accepting the application for recognition of work-related injuries, the social insurance administrative department may, according to the needs of examination and verification, investigate and verify the accident injuries, and the employing units, employees, trade union organizations, medical institutions and relevant departments shall provide assistance. The diagnosis of occupational diseases and the appraisal of diagnostic disputes shall be carried out in accordance with the relevant provisions of the Law on the Prevention and Control of Occupational Diseases. The social insurance administrative department will no longer investigate and verify the occupational disease diagnosis certificate or occupational disease diagnosis appraisal certificate obtained according to law.

The employer shall bear the burden of proof if the employee or his close relatives consider it to be work-related injury, but the employer does not consider it to be work-related injury.

Article 20 The social insurance administrative department shall, within 60 days from the date of accepting the application for recognition of work-related injury, make a decision on recognition of work-related injury, and notify in writing the employee or his close relatives who applied for recognition of work-related injury and the unit to which the employee belongs.
The social insurance administrative department shall make a decision on the determination of work-related injury within 15 days when accepting an application for determination of work-related injury with clear facts and clear rights and obligations.
If the determination of work-related injury needs to be based on the conclusion of the judicial organ or the relevant administrative department, the time limit for making the determination of work-related injury shall be suspended during the period when the judicial organ or the relevant administrative department has not made a conclusion.
If a staff member of the social insurance administrative department has an interest in the applicant for work-related injury determination, he shall withdraw.

Chapter IV Appraisal of Labor Capacity

Article 21 Where an employee suffers from work-related injury and is disabled or affects his/her ability to work after being treated for relatively stable injury, an appraisal of his/her ability to work shall be conducted.

Article 22 The appraisal of labor capacity refers to the grade appraisal of the degree of labor dysfunction and the degree of self-care disability.
The labor dysfunction is divided into ten levels of disability, the heaviest is level 1, and the lightest is level 10.
There are three levels of self-care barriers: completely unable to take care of themselves, mostly unable to take care of themselves, and partially unable to take care of themselves.

The standards for labor capacity appraisal shall be formulated by the social insurance administrative department of the State Council in conjunction with the health administrative department of the State Council and other departments.

Article 23 The employing unit, injured workers or their close relatives shall submit an application to the labor capacity appraisal committee of a city divided into districts, and provide the decision on the identification of work-related injuries and the relevant data on medical treatment of work-related injuries.

Article 24 The labor capacity appraisal committees of provinces, autonomous regions and municipalities directly under the Central Government and the labor capacity appraisal committees of cities divided into districts shall be composed of representatives of the social insurance administrative departments, health administrative departments, trade union organizations, agencies and employers at the provincial, autonomous regions, municipalities directly under the Central Government and cities divided into districts, respectively.
The labor capacity appraisal committee shall establish a pool of medical and health experts. Medical and health professionals included in the expert pool shall meet the following requirements:
（1） Have the qualification for senior professional and technical posts in medical and health care;
（2） Master the relevant knowledge of labor capacity appraisal;
（3） Have good professional ethics.

Article 25 The labor capacity appraisal committee of a city divided into districts shall, after receiving the application for labor capacity appraisal, randomly select 3 or 5 relevant experts from the medical and health expert database established by it to form an expert group, which shall put forward appraisal opinions. The labor capacity appraisal committee of the city divided into districts shall make a conclusion on the labor capacity appraisal of the injured workers according to the appraisal opinions of the expert group; When necessary, a qualified medical institution may be entrusted to assist in relevant diagnosis.

The labor capacity appraisal committee of a city divided into districts shall make a conclusion on the labor capacity appraisal within 60 days from the date of receiving the application for the labor capacity appraisal. If necessary, the time limit for making a conclusion on the labor capacity appraisal may be extended by 30 days. The conclusion of the appraisal of labor capacity shall be promptly delivered to the units and individuals applying for the appraisal.

Article 26 If the unit or individual applying for appraisal is not satisfied with the appraisal conclusion made by the labor ability appraisal committee of a city divided into districts, it or he may, within 15 days of receiving the appraisal conclusion, apply to the labor ability appraisal committee of the province, autonomous region, or municipality directly under the Central Government for another appraisal. The conclusion of the labor capacity appraisal made by the labor capacity appraisal committees of provinces, autonomous regions and municipalities directly under the Central Government shall be the final conclusion.

Article 27 The appraisal of labor capacity shall be objective and fair. If a member of the labor capacity appraisal committee or an expert participating in the appraisal has an interest with the party concerned, he shall withdraw.

Article 28 After one year from the date when the conclusion of the appraisal of labor capacity is made, the injured worker or his close relatives, the unit to which he belongs or the agency in charge may apply for reexamination of the appraisal of labor capacity if they believe that the disability situation has changed.

Article 29 The time limit for the labor capacity appraisal committee to make a re appraisal and reexamine the appraisal in accordance with the provisions of Article 26 and Article 28 of these Regulations shall be implemented in accordance with the provisions of the second paragraph of Article 25 of these Regulations.

Chapter V Industrial Injury Insurance Benefits

Article 30 Employees who suffer from accidents or occupational diseases at work shall receive medical treatment for work-related injuries.
When treating work-related injuries, employees should seek medical treatment in the medical institution that signed the service agreement. In case of emergency, they can first go to the nearest medical institution for first aid.
If the expenses required for treatment of work-related injury conform to the directory of work-related injury insurance diagnosis and treatment items, the directory of work-related injury insurance drugs, and the hospitalization service standards of work-related injury insurance, they shall be paid from the work-related injury insurance fund. The social insurance administrative department under the State Council, together with the health administrative department under the State Council, the food and drug supervision and administration department and other departments under the State Council, shall formulate the catalogue of occupational injury insurance diagnosis and treatment items, the catalogue of occupational injury insurance drugs, and the hospitalization service standards for occupational injury insurance.

The food allowance for hospitalized workers with work-related injuries, as well as the transportation, board and lodging expenses for workers with work-related injuries who need to go to the hospital outside the overall planning area shall be paid from the work-related injury insurance fund, and the specific standards for the fund payment shall be stipulated by the people's government of the overall planning area.
Workers with work-related injuries who treat diseases not caused by work-related injuries do not enjoy medical treatment for work-related injuries and shall be treated according to the basic medical insurance method.

The expenses for the injured workers to go to the medical institution that has signed the service agreement for the rehabilitation of work-related injuries shall be paid from the work-related injury insurance fund if they meet the requirements.

Article 31 If administrative reconsideration or administrative litigation occurs after the social insurance administrative department has made a decision that is recognized as work-related injury, it shall not stop paying the medical expenses for work-related injury treatment to the injured workers during the period of administrative reconsideration or administrative litigation.

Article 32 Workers with work-related injuries may install artificial limbs, orthotics, artificial eyes, false teeth, wheelchair and other assistive devices for their daily life or employment needs upon the confirmation of the labor capacity appraisal committee, and the necessary expenses shall be paid from the work-related injury insurance fund according to the standards prescribed by the State.

Article 33 If an employee suffers from accident injury or occupational disease at work and needs to suspend work to receive medical treatment for work-related injury, the original wages and benefits shall remain unchanged during the period of suspension with salary, and the unit to which he belongs shall pay him monthly.

The shutdown period with salary is generally not more than 12 months. If the injury is serious or the situation is special, it can be appropriately extended after being confirmed by the labor capacity appraisal committee of a city divided into districts, but the extension shall not exceed 12 months. After assessing the disability level, the injured workers shall stop paying their original benefits and enjoy disability benefits in accordance with the relevant provisions of this Chapter. If an injured worker still needs treatment after the period of suspension with salary expires, he/she shall continue to enjoy medical treatment for work-related injuries.

If an injured worker who is unable to take care of himself or herself needs nursing care during the period of suspension with pay, the unit to which he or she belongs shall be responsible.

Article 34 If an injured worker has been assessed as disabled and has been confirmed by the appraisal committee of labor capacity to need living care, the living care fee shall be paid monthly from the industrial injury insurance fund.

The living care cost is divided into three levels: totally unable to take care of themselves, mostly unable to take care of themselves or partially unable to take care of themselves